Trial reportNicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco2017
Cigarette Graphic Warning Labels Are Not Created Equal: They Can Increase or Decrease Smokers' Quit Intentions Relative to Text-Only Warnings.
Trial report in Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 53 citations in OpenAlex.
- Campaign messages to support pictorial health warning labels for little cigars and cigarillos: an online survey-based experiment.BMJ open · 2025Trial
- Operating on Anxiety: Negative Affect toward Breast Cancer and Choosing Contralateral Prophylactic Mastectomy.Medical decision making : an international journal of the Society for Medical Decision Making · 2023Trial
- Mediational Effects on Motivation to Quit Smoking After Exposure to a Cigarette Pictorial Warning Label Among Young Adults.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2022Trial
- Higher negative emotions in response to cigarette pictorial warning labels predict higher quit intentions among smokers.Tobacco control · 2020Trial
- "That's probably what my mama's lungs look like": how adolescent children react to pictorial warnings on their parents' cigarette packs.BMC public health · 2018Trial
- Perceptions of cannabis warnings and recommendations for improvement: a qualitative study with people who use cannabis from the United States.BMC public health · 2025Article
- The Role of Harm Visibility for Pictorial Health Warning Labels on Cigars.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2025Article
- An observational study on the association between smoking and relative poverty in China: Evidence from two waves of China Family Panel Studies.Tobacco induced diseases · 2025Article
- Effects of emotional arousal on the neural impact and behavioral efficacy of cigarette graphic warning labels.Addiction (Abingdon, England) · 2023Observational
- Smoking cessation policy and treatments derived from the protective motivation of smokers: a study on graphic health warning labels.Frontiers in psychology · 2023Article
- Evaluation of the smoking cessation effects of QuitAction, a smartphone WeChat platform.Tobacco induced diseases · 2023Article
- Exploring factors that influence COVID-19 vaccination intention in China: Media use preference, knowledge level and risk perception.Frontiers in psychology · 2022Article
- Harm Perception in Response to Pictorial Warning Labels Predict Higher Non-Smoking Intention among Korean Adolescents.International journal of environmental research and public health · 2021Article
- Smoking cessation rate and factors affecting the success of quitting in a smoking cessation clinic using telephone follow-up.Tobacco induced diseases · 2021Article
- Responses to Graphic Warning Labels among Low-income Smokers.American journal of health behavior · 2020Article
- Numeracy and memory for risk probabilities and risk outcomes depicted on cigarette warning labels.Health psychology : official journal of the Division of Health Psychology, American Psychological Association · 2020Article
- Pictorial Cigarette Pack Warnings Increase Some Risk Appraisals But Not Risk Beliefs: A Meta-Analysis.Human communication research · 2020Article
- Research on Youth and Young Adult Tobacco Use, 2013-2018, From the Food and Drug Administration-National Institutes of Health Tobacco Centers of Regulatory Science.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2020Review
- Do graphic health warning labels on cigarette packages deter purchases at point-of-sale? An experiment with adult smokers.Health education research · 2019Article
- Pictorial Warning Labels and Memory for Cigarette Health-risk Information Over Time.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
introductionCigarette graphic-warning labels elicit negative emotion. Research suggests negative emotion drives greater risk perceptions and quit intentions through multiple processes. The present research compares text-only warning effectiveness to that of graphic warnings eliciting more or less negative emotion.
methodsNationally representative online panels of 736 adult smokers and 469 teen smokers/vulnerable smokers were randomly assigned to view one of three warning types (text-only, text with low-emotion images, or text with high-emotion images) four times over 2 weeks. Participants recorded their emotional reaction to the warnings (measured as arousal), smoking risk perceptions, and quit intentions. Primary analyses used structural equation modeling.
resultsParticipants in the high-emotion condition reported greater emotional reaction than text-only participants (bAdult = 0.21; bTeen = 0.27, p's < .004); those in the low-emotion condition reported lower emotional reaction than text-only participants (bAdult = -0.18; bTeen = -0.22, p's < .018). Stronger emotional reaction was associated with increased risk perceptions in both samples (bAdult = 0.66; bTeen = 0.85, p's < .001) and greater quit intentions among adults (bAdult = 1.00, p < .001). Compared to text-only warnings, low-emotion warnings were associated with reduced risk perceptions and quit intentions whereas high-emotion warnings were associated with increased risk perceptions and quit intentions.
conclusionWarning labels with images that elicit more negative emotional reaction are associated with increased risk perceptions and quit intentions in adults and teens relative to text-only warnings. However, graphic warnings containing images which evoke little emotional reaction can backfire and reduce risk perceptions and quit intentions versus text-only warnings. IMPLICATIONS: This research is the first to directly manipulate two emotion levels in sets of nine cigarette graphic warning images and compare them with text-only warnings. Among adult and teen smokers, high-emotion graphic warnings were associated with increased risk perceptions and quit intentions versus text-only warnings. Low-emotion graphic warnings backfired and tended to reduce risk perceptions and quit intentions versus text-only warnings. Policy makers should be aware that merely placing images on cigarette packaging is insufficient to increase smokers' risk perceptions and quit intentions. Low-emotion graphic warnings will not necessarily produce desired population-level benefits relative to text-only or high-emotion warnings.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.